Safety and long-term outcome of a new concept for surgical adhesion-reduction strategies (Prevadh): a prospective, multicenter study.

BACKGROUND/AIMS: No agent has been consistently effective in preventing formation of peritoneal adhesions and postoperative bowel obstruction after abdominal surgery. The aim of this prospective multicenter study was to assess clinical safety and efficiency of a new adhesion-reduction barrier METHODOLOGY: Between September 2000 and April 2001, Prevadh was used in 78 patients. Operative procedures included 25 hepatic resections, 7 cholecystectomies, 32 colonic resections, 7 protectomies, 3 colostomy or recovery of continuity, 1 gynaecologic surgery and 3 others. Eleven patients were operated on by laparoscopy and 67 by laparotomy. RESULTS: The overall incidence of abscesses and wound complications was 2.4% and 9% respectively. After a mean follow-up of 36 months (range: 4-51 months), no patients experienced adverse events related to the adhesion barrier. Surgical reoperative procedures were performed in 10 patients for unrelated causes and no bowel obstruction occurred within the protected area. CONCLUSIONS: This study confirmed the safety of Prevadh adhesion barrier and suggested that this resorbable barrier might provide prevention from adhesion formation on peritoneal injured surfaces. However, a large randomized controlled trial remains necessary to prove the real effectiveness of adhesion barriers on clinical long-term outcome.

SPECT/CT in localization of parathyroid adenoma or hyperplasia in patients with previous neck surgery.

PURPOSE: Single photon emission computed tomography/computed tomography (SPECT/CT) now makes it possible to use combined morphologic CT and functional scintigraphy information. It has proved useful for localization of abnormal parathyroid glands, especially in the case of an ectopic gland. We experienced that it was also beneficial for patients with a history of previous neck surgery, and we report 4 cases in this entity. MATERIALS AND METHODS: Four patients with prior neck surgery and hyperparathyroidism underwent parathyroid Tc-99m MIBI scintigraphy with SPECT/CT. Two patients had undergone surgery for hyperparathyroidism and 2 had undergone thyroidectomy, 1 for thyroid cancer and 1 for multinodular goiter. Parathyroid hormone levels were assessed during surgery, and patients were followed several months after treatment. RESULTS: SPECT/CT successfully localized the abnormal gland, including an uncommon anterior situation for which previous surgery guided by planar imagery failed to cure the hyperparathyroidism. It allowed efficient surgical treatment, as confirmed by parathyroid hormone level normalization, without complications and with a relatively short operation time in those challenging cases. CONCLUSIONS: SPECT/CT seems to be a useful tool for presurgical assessment in hyperparathyroidism, not only for ectopic glands but also for patients with previous neck surgery.

Bilateral Thyroid and Ultimobranchial Medullary Carcinoma.

The ultimobranchial bodies in human embryos develop from the fourth and fifth branchial pouch complexes along with thymic and parathyroid tissue. They become incorporated within the lateral thyroid lobes and are believed to be involved in the development of C-cells. We report a case of an unusual bilateral thyroid and neck prelaryngeal medullary carcinoma in a 23-year-old male patient who belongs to a multiple endocrine neoplasia type 2a (MEN type 2a) family with thyroid tumors and pheochromocytomas. The medullary carcinoma was located in an abnormal cystic structure that seems to be a remnant of the ultimobranchial body (UBB) in the neck. Within the contralateral thyroid lobe, the medullary carcinoma was associated with C-cell hyperplasia.